2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE
Manufacturers and 340B
Why do manufacturers participate in 340B (and Medicaid)? o Manufacturers are not required to participate – they choose to participate and offer discounts o Participation is the only way to receive Medicare Part B and Medicaid reimbursement
Slide19of31FromTHorn,MS atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDS ProgramCLINICALCONFERENCE, IAS USA.
340B and RWHAP
RWHAP grantees are essential public health care programs and therefore eligible for 340B Drug Pricing Program RWHAPs also subject to extensive restrictions on how 340B can be used: program-eligible PLWHIV, ”additive” use consistentwith grant terms HRSA Policy Clarification Notice (PCN) 15-03 Most RWHAP programs – or their contractpharmacies – access up-front discounts ADAPs, under RWHAP Part B, may choose up-frontdiscountsand/or rebatespaid by manufacturer ADAP Crisis Task Force negotiates supplemental discounts/rebates with manufacturers – agreements with all ARV manufacturers on behalf of all ADAPs
Slide20of31FromTHorn,MS atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDS ProgramCLINICALCONFERENCE, IAS USA.
340B Discount and Program Income Basics
340B entities subject to a minimum discount of 23.1% off the Average Manufacturer Price; “Best Price” adjustment also possible When manufacturer takes a price increase that exceeds the Consumer Price Index for All Urban Costumers (CPI-U), an additional rebate – or
“inflation penalty” – is added to base discount Achieves prescription drug cost containment
Revenue, or “program income,” is generated when clinics are able to purchase the drug at a discounted rate but are reimbursed by third- party payers at a higher usual and customary rate
Slide21of31FromTHorn,MS atNewOrleans,LA,December4-7,2019,RyanWhiteHIV/AIDS ProgramCLINICALCONFERENCE, IAS USA.
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